Endoscopic device

ABSTRACT

An instrument for endoscopic subfascial discission of perforans veins (ESDP) consists of a surgical endoscope (1) and a tube (9). The surgical endoscope (1) contains an optical image recording and transmission system, a fiber-optic lighting system and a working channel (4). A lateral handle (14) forms in an obtuse angle with the surgical endoscope and has at least one reproduction and lighting system (8, 6) guided to coupling spots (5, 7) provided at the proximal end of tube instrument. The distal end of the tube (9) extends beyond the distal end of be surgical endoscope (1) and is designed as a thicker, atraumatic lip (10) that contains a suction channel (12) diametrically arranged to a front lens system (16) and connected through a space (11) between the shaft (2) and the tube (9) to a connection fitting (13) for a suction hose (15).

BACKGROUND OF THE INVENTION

The invention relates to an endoscopic device, in particular to aninstrument for endoscopic subfascial discision of perforans veins(ESDP). About 10% to 15% of the adult suffer from a distinct varix ofthe lower extremities, up to 16% of these patients have insufficientperforans veins. In the course of the medical treatment of a primaryvarix and of trophic skin disorders due to a post-thrombosis or to avarix these insufficient perforans veins are subfascially eliminated. Inthe course thereof the previous surgical methods require an extendeduncovering of the perforans veins and very often suffered frompost-surgical wound healing troubles or they are disadvantageous due tolow precision.

In the course of the Minimal Invasion Surgery the endoscopic subfascialdiscision of perforans veins (ESDP) was developed by Dr. G. Hauer whichis up to now considered as the most effective therapeutical principle.The instruments developed in connection with the aforesaid (refer toJugenheimer, M; Junginger, Th.: PHLEBOLOGY, 4th. annual 8/92, p. 540ff.)comprises cold light operation robes of different diameter, aconventional laparoscope and accessories such as bi-polar coagulationforceps and endoscopic scissors. These standard components fromdifferent fields of endoscopy have only slightly been modified so thatthe instrumentation naturally shows a number of essential disadvantages.A later installed means for locking the instruments to the surgicallaparoscope was not very successful in practice. A simultaneous workingwith the tube, the endoscope, and with the instrument just in userequires the helping hand of an assistant. For the comparatively powerconsuming manipulation of the tube the handle thereof is considered asbeing not stable enough. An essential disadvantage is the insufficientquality of the optical system of the surgical laparoscope, the lowaperture of which sometimes renders the reproduction by conventionalCCD--endo-cameras questionable due to the poor illumination conditionsat the surgical situs (high absorption by severe bleeding). Thedirection of sight which usually is 5° to 10° with surgical laparoscopesgenerally does not ensure a sufficient sight of the instrument inserted.The manipulation is additionally impeded by the equipment lines for thecamera, the high frequency devices, the fiber-optical illuminationmeans, and for the coagulation gas exhaust which run in differentdirections relative to the axis of instrument.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide an endoscopicdevice, particularly for the ESDP which is best suited for the medicalprocedure and which obviates the disadvantages of the previous devicesmentioned hereinabove.

The object is realized by the features specified in the first claim.

BRIEF DESCRIPTIONS OF THE INVENTION

The invention will be explained in more detail in connection with thefollowing example of embodiment, and wherein

FIG. 1 shows a lateral, partially sectional view of an endoscopic deviceaccording to the invention, and

FIG. 2 shows an enlarged, partially sectional, schematic view of thedistal end portion of an endoscopic device according to FIG. 1.

DETAILED DESCRIPTION OF THE INVENTION

The inventional device comprises a specifically embodied surgicalendoscope 1, relative to an insertable shaft 2 of which a tube 9 islockably mounted by means of a screw 3 or any other suitable lockingmeans. The shaft 2 of the surgical endoscope includes an optical systemfor image detection and transfer, fiber-optical light cables for lighttransmission from an external cold light source to the surgical situs,and an operation channel 4 for insertion of surgical instruments such asendoscopic knives, scissors or instruments for the surgical highfrequency surgery. A handle 14 provided at the proximal end portion ofthe device permits operation of the device with an adequate amount ofmanual power. The illumination system and the optical imaging system runafter a bend within the interior of the handle 14 to the end portion ofthe latter, where a socket 5 and a coupling 7, respectively, permit theconnection of a light cable 6 of an external cold light source and of acamera 8 for transmitting the image to a monitor, respectively. It lieswithin the scope of the invention to install CCD-cameras, when used, forexample, in said handle. The robe 9 is locked to the shaft 2 of thesurgical endoscope. The distal end portion of the tube 9 is embodied asa bulgy a-traumatic lip 10 and projects over the end portion of theshaft of the surgical endoscope. Exhaust gases or the like which, forexample, occur in the event of HF-coagulation can be sucked off throughan intermediate space 11 constituted by preferably different embodyingthe external and the internal shaft diameters. The distal end portion ofthe shaft is guided free from backlash in the interior of the lip 10. Achannel 12 is provided on the interior lip in opposition to theoperation channel of the surgical endoscope which channel establishes alumen as junction to the intermediate space 11 required for suction.According to the invention the channel 12 is in diametral opposition toa front lens 16 and the intermediate space 11 is defined byeccentrically arranging the shaft 2 and the robe 9 substantially on thechannel 12 side portion. A hose coupling 13 for connecting a suctionhose 15 is arranged in a common plane with and in direction of thehandle 14 which substantially eliminates any obstruction of thesurgeon's work. According to the invention the optical axis X--X of afront lens and a lens system 16, respectively, is defined to include anangle of 30° relative to the central axis of the shaft 2. Theinventional device is preferably but not exclusively intended for theprocedure of endoscopical subfascial discision of perforans veins(ESDP). Under maintaining the same inventional setup a device also forother fields of endoscopy is provided by a simple geometricalmodification, for example, by an increase of diameter for said shaft andsaid tube. The present invention provides a device for the ESDPprocedure which permits the access to remote trophically affected sitesso that wound healing disorders are substantially eliminated. Consideredunder an endoscopical point of view the fascia cruris can be discisedcompletely and without any incidental wounds. The medial and dorsalgroups of perforans veins of the shank are safely detected and severed,irrespective of whether or not a precise pre-surgical localizing in thecase of ulcus cruris is feasible.

We claim:
 1. An endoscopic device comprising:a surgical endoscope withina tube; said surgical endoscope including an optical system fordetecting and transmitting images, a fiber-optical illumination systemand an operation channel for axial introduction of surgical instrumentsto a surgical site; said surgical endoscope being laterally provided ata proximal end portion with a handle, the handle being at an obtuseangle with said surgical endoscope and said tube, said handle (14) beingprovided with at least one imaging and illumination system in itsinterior extending to an end portion of the handle to coupling means forconnecting to image reproduction equipment and a light sourcerespectively; said optical and illumination system including a lenssystem having a front lens at a distal end of said surgical endoscope;said tube having an a-traumatic lip at a distal end thereof extendingbeyond the distal end of said surgical endoscope to form an open-endedtubular cavity encompassing said front lens and a distal opening of saidoperation channel, the a-traumatic lip having a diameter greater than aremainder of said tube; said tube having an inner diameter greater thanan outer diameter of said surgical endoscope, said surgical endoscopebeing eccentrically disposed with said tube to define an intermediatespace therebetween; and said a-traumatic lip including a suction channelin diametral opposition to said front lens of said lens system forremoval of gases away from said front lens, said suction channelcommunicating with said intermediate space and said intermediate spacecommunicating with a suction coupling means arranged substantially in aplane with and in direction of said handle for connecting thereto asuction source.
 2. An endoscopic device as claimed in claim 1, whereinan optical axis of said front lens is at an angle of about 30° relativeto a central axis of said surgical endoscope.
 3. An endoscopic device asclaimed in claim 1, wherein a camera for image detection is installedwithin said handle.
 4. An endoscopic apparatus comprising:an endoscopicshaft having a proximate end near an operator thereof and a distal endfor insertion into a patient; said endoscopic shaft including anoperating channel extending from said proximate to said distal end forreceiving surgical instruments therein and introducing said surgicalinstruments axially at said distal end to a surgical site, optical meansfor illuminating an area to be operated upon and transmitting an imageto an image reproduction device; said optical means including a frontlens at said distal end of said endoscopic shaft; a tube having a largerinner diameter than an outer diameter of said endoscopic shaft, saidendoscopic shaft being eccentrically disposed within said tube anddefining a suction channel between said tube and said endoscopic shaft;said tube having a circumferential ring at a distal end thereofextending beyond said distal end of said endoscopic shaft to form anopen-ended tubular cavity whereby an end opening of said operatingchannel and said front lens are recessed within said open-ended tubularcavity from a distal end of said circumferential ring; saidcircumferential ring defining a channel on an inner surface thereofcommunicating said open-ended tubular cavity with said suction channel;and first coupling means for connecting said suction channel to asuction source, and second coupling means for connecting said opticalmeans to an illumination and image reproduction apparatus.
 5. Theendoscopic apparatus of claim 4 further comprising:a handle disposed atthe proximate end of said endoscopic shaft and at an obtuse anglerelative to said endoscopic shaft; and said handle accommodating passageof said optical means therethrough to a lower end thereof whereat saidsecond coupling means are disposed such that connections to said secondcoupling means extend downward away from said proximate end of saidendoscopic shaft eliminating obstruction of access to said operatingchannel during use.
 6. The endoscopic apparatus of claim 5 wherein saidfront lens has an optical axis at an angle of about 30° relative to alongitudinal axis of said endoscopic shaft to permit viewing of surgicalinstruments axially extending from said end opening of said operatingchannel, through said open-ended tubular cavity to an operative site ata distal end of said circumferential ring.
 7. The endoscopic apparatusof claim 6 wherein said channel of said circumferential ring is disposeddiametrically opposite said front lens whereby fumes generated duringsurgical procedures are drawn off away from said front lens and saidsurgical site to maintain a clear view of said surgical site.
 8. Theendoscopic apparatus of claim 4 wherein said front lens has an opticalaxis at an angle of about 30° relative to a longitudinal axis of saidendoscopic shaft to permit viewing of surgical instruments axiallyextending from said end opening of said operating channel, through saidopen-ended tubular cavity to an surgical site at a distal end of saidcircumferential ring.
 9. The endoscopic apparatus of claim 8 whereinsaid channel of said circumferential ring is disposed diametricallyopposite said front lens whereby fumes generated during operatingprocedures are drawn off away from said front lens and said surgicalsite to maintain a clear view of said surgical site.
 10. An endoscopicapparatus comprising:an endoscopic shaft having a proximate end near anoperator thereof and a distal end for insertion into a patient; saidendoscopic shaft including an operating channel extending from saidproximate to said distal end for receiving operating instrumentstherein, optical means for illuminating an area to be operated upon andtransmitting an image to an image reproduction device; said opticalmeans including a front lens at said distal end of said endoscopicshaft; a tube having a larger inner diameter than an outer diameter ofsaid endoscope shaft, said endoscope shaft being eccentrically disposedwithin said tube and defining a suction channel between said tube andsaid endoscopic shaft; said tube having a circumferential ring at adistal end thereof extending beyond said distal end of said endoscopicshaft to form an open-ended tubular cavity whereby an end opening ofsaid operating channel and said front lens are recessed within saidopen-ended tubular cavity from a distal end of said circumferentialring; said circumferential ring defining a channel on an inner surfacethereof communicating said open-ended tubular cavity with said suctionchannel, said channel of said circumferential ring being disposeddiametrically opposite said front lens whereby fumes generated duringsurgical procedures are drawn off away from said front lens and aoperative site to maintain a dear view of said surgical site; and firstcoupling means for connecting said suction channel to a suction source,and second coupling means for connecting said optical means to anillumination and image reproduction apparatus.
 11. The endoscopicapparatus of claim 10 wherein said front lens has an optical axis at anangle of about 30° relative to an axis of said endoscopic shaft topermit viewing of surgical instruments axially extending from said endopening of said operating channel, through said open-ended tubularcavity to an operative site at a distal end of said circumferentialring.